RN Utilization Review Specialist — Care Coordination

USA Health

Mobile (AL)

In loco

USD 70.000 - 100.000

Tempo pieno

11 ore fa

Candidati tra i primi

Aumenta le possibilità di ricevere una risposta da questo datore di lavoro

Il tuo curriculum e una lettera di presentazione personalizzati, che corrispondono esattamente a ciò che sta cercando.

Supera i filtri ATS

Descrizione del lavoro

USA Health in Mobile, AL is seeking a dedicated Utilization Review Nurse to join our team. You will review medical records, determine appropriate level of care, and collaborates with physicians, nurses, and payors to ensure compliant, timely, and cost-effective patient care.

The role requires RN licensure and 2 years of nursing experience; a Bachelor’s or Master’s in Nursing is preferred. Prior Utilization Review experience is a plus, and you will help maintain accurate documentation within the

Competenze

Graduation from an accredited nursing program with 2 years of professional nursing experience.
Bachelor's or Master's degree in nursing preferred.
Utilization Review experience preferred.
RN licensure required in Alabama or compact state.
Education/experience may substitute for other requirements.

Mansioni

Performs utilization review activities per policy and payor requirements, including reviews and prior authorizations.
Analyzes medical records to support reviews.
Collaborates with care teams to plan safe discharge and timely inpatient flow.
Ensures optimal reimbursement through proper utilization review processes.
Communicates with providers by phone, in person, and email.
Maintains documentation and participates in performance improvement activities.